MICHIGAN DEPARTMENT OF ENVIRONMENTAL QUALITY - …
MICHIGAN DEPARTMENT OF ENVIRONMENT, GREAT LAKES, AND ENERGY – OIL, GAS, AND MINERALS DIVISION
ANNULAR PRESSURE TEST
| |Permit Number |
| | |
| |Well name & No. |
| | |
| |Surface location |
| | 1/4 of 1/4 of 1/4, Section T R |
|Name and address of permittee |Township County |
| | |
| | |
| | |
| | |
| | |
| |Well type: Waste Disposal (Class I) Solution Mining (Class III) |
| | |
| |Spent Brine Return (Class V) Storage |
| |Natural Brine Production |
|Date of test |Casing size |Tubing size (if applicable) |
| | | |
|Type of gauge |Packer type/model |Packer depth (feet) |
| | | |
|inch face psi range psi increments | | |
|New gauge Yes No (if no, enter the date of test calibration) |Top of Permitted Injection Zone (feet) |
| | |
|Calibration Certification Submitted? Yes No | |
|Fluid return (gallons) |
| |
|Purpose of Test and Test Results Test Results Requirements |
|(NOTE: The difference between the testing pressure and the tubing For Class III and Brine Production wells, readings must be taken at |
|pressure shall not be less than 100 psig at the time of the test). least every 10 minutes for a minimum of 30 minutes. For Class I, Class |
| |
|V, and Storage wells, readings must be taken every 10 minutes for 60 |
|5-year or annual test? Yes No minutes. Annulus test pressure shall not be less than 300 psig or |
|New permitted well? Yes No 100 psig above max. injection pressure. If test is unwitnessed, original After rework?|
|Yes No chart must be submitted. |
|Other? Yes No |
| |
| |PRESSURE READINGS |
|TIME |ANNULUS |TUBING |
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Test Pressures: For Disposal (Class I/Class V) & Storage Wells - Max. Allowable Pressure Change (3%): Initial Pressure x 0.03 psi = psi
For Class III & Artificial/Natural Brine Prod. Wells - Max. Allowable Pressure Change (5%): Initial Pressure x 0.05 psi = psi
Test Passed Test Failed Test Period Pressure Change psi
NOTE: If test fails, the well must be shut-in, no injection can occur, and the EGLE-OGMD shall be notified within 24 hours. Corrective action may be needed and the well re-tested. An Authorization to Inject must be received before injection can commence.
|Was test witnessed by a EGLE-OGMD representative? Yes No If yes, name of EGLE-OGMD representative |
|CERTIFICATION “I state that I am authorized by said owner. This report was prepared under my supervision and direction. The facts stated herein are true, accurate and |
|complete to the best of my knowledge.” |
| |
| |
|Company Representative Date |
Mail original to the appropriate Oil, Gas, and Minerals Division District Office
EQP 7606MW (rev. 05/2019)
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[pic]
By authority of Part 625 of
Act 451 PA 1994, as amended.
Non-submission and/or falsification of this information
may result in fines and/or imprisonment.
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